Diagnosis of Malignancy of Adult Mediastinal Tumors by Conventional and Transesophageal Echocardiography

Background： Transesophageal echocardiography （TEE） is a well-established method for detecting and diagnosing heart tumors. In contrast, its role in assessing the presence, growth and evidence of malignant tumors originating from mediastinal sites remains unclear. The aim of this study was to compare the diagnostic impact of TEE and transthoracic echocardiography （TTE） for determining the localization, growth and malignancy of adult mediastinal tumors （MTs）. Methods： In a prospective and investigator-blinded study, we evaluated 144 consecutive patients with MT lesions to assess the diagnostic impact of TEE and TTE for detecting the presence of tumors spreading both inside and outside of the heart and for determining infiltration and invasion using pathological examination results as a reference. Results： All tumor lesions were diagnosed and carefully evaluated by biopsy. Biopsy revealed malignant tumors in 79 patients and benign tumors in 65 patients. When compared to histological findings, TEE predicted malignancy from the presence of tumors spreading both inside and outside of the heart and from infiltration and invasion in 49/79 patients （62.0%）. TTE predicted malignancy in only 8/79 patients （10.1%, P 〈 0.005）. TEE visualized tumor lesions in 130 patients （90.3%） while the TTE visualized tumor lesions in 110 patients （76.4%） and was less effective at detecting MT lesions （P 〈 0.001 ）. TTE and TEE could detect anterior MTs and adequately verified MTs （P 〉 0.05）： TEE detected medium MTs better than TTE （P 〈 0.001 ）. Conclusions： TEE is effective and superior to TTE for predicting the localization and growth of MTs as well as for accessing evidence of tumor malignancy. TTE and TEE were able to detect anterior MTs; TEE was able to detect medium MT better than TTE.

Image features of two rare mediastinal tumors: schwannoma of intrathoracic phrenic nerve and clear cell chondrosarcoma of the rib

The current report focuses on two patients of the same age who presented similar appearances on initial anteroposterior chest images. Follow-up images showed superoanterior and superoposterior mediastinal lesions. The first patient with noninvasive cystic thymoma was suspected before surgery, while the pathologic diagnosis was intrathoracic phrenic nerve schwannoma. The second patient was with an asymmetric, dumbbell-shaped paravertebral tumor over T3 and T4 on the left side. The preoperative diagnostic images were interpreted as showing a neurogenic tumor. However, the pathologic report was cell chondrosarcoma.

DIAGNOSIS AND TREATMENT OF MEDIASTINAL NEUROGENIC TUMORS--REPORT OF 110 CASES

Object.To study the clinical manifestations,diagnostic methods,surgical management ,and prognosis of various neurogenic mediastinal tumors.Method.One hundred and ten cases of neurogenic tumors of mediastinum were reviewed and retro-spectively analyzed.Results.Operative or hospitalization death happened in2cases,complications occurred in8cases,mostly were Horner’s syndrome or recurrent nerve paralysis.During the follow?up,there were2recur-rences in102benign tumors,and4cases of neurofibrosarcoma or malignant neurilemmoma died within3years postoperatively.Conclusion.Most mediastinal neurogenic tumors are benign.It is enough to establish diagnosis by chest X?ray and CT scan.There are different features in the clinical manifestations,diagnosing methods,and surgical management for the dumbbell tumors.Minimal invasive surgery and video?assisted thora-coscopy surgery(VATS)have a special value in treatment of the selected neurogenic mediastinal tumors.Benign neurogenic tumors rarely recur after complete resection,whereas malignant neurogenic tumors have poor prognosis.

One Case of Right Posterior Mediastinum Intraneural Hemangioma Misdiagnosed as Neurilemmoma

Although rare, intraneural hemangiomas should be considered in the differential diagnosis of peripheral nerve lesions. We report on a 59-year-old female patient, who was admitted to the hospital due to the discovery of bilateral breast masses for 3 months, there was no paresthesia or dyskinesia. The patient accidentally found a mass in the right upper mediastinum while completing a plain chest X-ray, initially suspected as a benign neurilemmoma on CT. Surgical resection and pathological analysis confirmed an intraneural hemangioma. Unexpectedly, the patient developed new-onset right upper limb numbness and paresthesia 3 months post-operatively, probably related to surgical nerve injury. This case underscores the importance of maintaining a broad differential for mediastinal masses, and the potential for iatrogenic neurological complications when managing these rare, yet vascular lesions.

REFLECTIONS ON SURGICAL TREATMENT OF 214 CASES OF PRIMARY MEDIASTINAL TUMOR

Our hospital documented 214 cases of primary mediastinal tumor from May 1957 to July 1995. They were treated surgically, There were 184 benign cases (85. 98% ), and 30 malignant cases (14.02 % ). Among them, there were 63 cases of neurogenic tumor (29.43 % ), 48 cases of thymic tumor (22. 4% ), 41 cases of teratoid tumor (19. 16% ), 12 cases of bronchial cyst (5. 61% ), and 9cases of intrathoracic adenoma of thyroid (4. 21%). The authors mainiy discuss the early diagnosis,tumor variety, operating incisions, and operating essentials.

NUT midline carcinoma as a mediastinal tumor treated with cisplatin: A case report

NUT(nuclear protein of the testis)midline carcinoma(NMC)is a rare malignant and poorly differentiated squamous cell tumor that typically presents in midline structures of the head,neck and mediastinum with high degree of invasion and mortality,which occurs at any age,especially in teenagers and young people.We report a case of NMC presented as a mediastinal tumor.A 14-year-old female patient who presentedwith progressive dyspnea,cough with expectoration,and right pleural effusion and mediastinal space-occupying.Cisplatin(DDP)-based chemotherapy was performed.The prognosis is bad with an overall survival of 3 months.

A Case of Multiple Sexually Transmitted Diseases (STDs),with Stevens-Johnson Syndrome and Mediastinal Tumor

A 29-year-old man was admitted for erythema, papules and erosions. Erosions and purulent secretions were seen in the circumference of the mouth, eyes, oral mucosa,tongue, and preputium. Conjunctivas were swollen and the urethral orifice was red, both were accompanied by purulent secretions. Multiple vesicles were shown in the penis.The patient was diagnosed with:①Stevens-Johnsonsyndrome;②gonococcal ophthalmoblennorrhea;③nongonococcal urethritis, gonococcal urethritis;④genital herpes;⑤mediastinal tumor.

Nursing Care of a Case of Mediastinal Tumor Resection Combined with Postoperative Thoracic Hemorrhage after Video-assisted Thoracoscopic Surgery(VATS)

Objective: To summarize the nursing experience of a patient withpostoperative intrathoracic hemorrhage after thoracoscopic-assistedresection of the right upper mediastinal tumor through the original incision.Methods: Summarize the main points of nursing care of postoperativeintrathoracic hemorrhage after thoracoscopic mediastinal surgery, includingobservation and nursing when internal hemorrhage occurs after operation,respiratory management, activity management and pain managementmeasures. Result: After careful care, the patient recovered and dischargedsmoothly. Conclusion: It is particularly important to observe the overallobservation and take timely corresponding nursing measures for patientswith intrathoracic hemorrhage after thoracoscopic mediastinal surgery.

A single institution, retrospective study of treatment experience in primary mediastinal germ cell tumors： elucidating the significance of systemic chemotherapy

Background Primary malignant germ cell tumors （GCTs） of mediastinum are rare neoplasms.We introduce our institutional experience in managing patients with primary malignant GCTs of the mediastinum,focusing on the analysis of therapeutic modalities.Methods A retrospective review was done in 39 consecutive patients with mediastinal malignant GCTs treated in our institution between 1991 and 2007.Results A total of 39 patients were enrolled in this study with a median age of 27 years.The 5-year overall survival （OS） and progression-free survival （PFS） rates of the whole population were 60.2% and 57.7%,respectively.Stratified by the histology,18 patients （46.2%） had seminoma and 21 patients （53.8%） had nonseminomatous germ cell tumors （NSGCTs）.The 5-year OS rate of patients with seminoma was 87.4% as compared with 36.7% in patients with NSGCTs （P=-0.0004）.The 5-year PFS rate was also significantly higher in seminoma patients （87.4% vs.31.6%,P=-0.003）.For 19 patients with NSGCTs managed with multi-modality treatment,chemotherapy exposure appeared to impact the prognosis.The 5-year OS rate was 44.9% in patients with chemotherapy exposure as compared with 20.0% in patients without it （P=0.43）.Conclusion Our study confirmed the significance of systemic chemotherapy in the treatment of primary mediastinal GCTs.

Rare solitary splenic metastasis from a thymic carcinoma detected on fluorodeoxyglucose-positron emission tomography:A case report

BACKGROUND Thymic carcinoma is a rare,aggressive tumor arising from the thymus.In less than 7%of patients with thymic carcinoma,extrathoracic metastases occur in the extrathoracic lymph nodes,liver,and bone.Isolated splenic metastasis can occur but is very uncommon.To date,only 2 cases of splenic metastases from thymic carcinoma have been reported.CASE SUMMARY A 45-year-old man presented with chronic cough,dyspnea,persistent hoarseness and unintentional weight loss 17 kgs in 6 mo.Neck magnetic resonance imaging revealed a large,lobulated,soft-tissue mass measuring 5.4 cm×6.6 cm×3.8 cm which involved the left superior mediastinum and supraclavicular fossa.Chest computed tomography(CT)revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery,right and left carotid arteries,and left subclavian artery in the mediastinum.A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey.The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum,over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa.CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis.The patient was diagnosed of thymic carcinoma,cT2N2M1b,stage IVb.CONCLUSION A fluorodeoxyglucose(FDG)-positron emission tomography(PET)scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging.Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.

Surgical therapy for hemangioma of the azygos vein arch under thoracoscopy: A case report

BACKGROUND Azygos vein aneurysms are extremely rare,and their pathogenesis is not clear.The overwhelming majority of patients have no obvious clinical symptoms and are found to have the disease by physical examination or by chance.There are few reports on the diagnosis of and treatment strategy for this disease.Moreover,the choice of therapeutic schedule and the treatment window are controversial.CASE SUMMARY We report a case of azygos vein arch aneurysm in a 53-year-old woman.The patient had symptoms of back pain,chest tightness,and choking.Enhanced chest computed tomography showed a soft-tissue mass in the right posterior mediastinum,which was connected to the superior vena cava.The enhancement degree in the venous phase was the same as that of the superior vena cava.The patient received video-assisted thoracoscopic surgery.After the operation,her back pain disappeared,and her dysphagia and chest tightness were also significantly relieved.The postoperative pathology confirmed hemangioma.The patient was discharged on the seventh day after surgery without any complications.CONCLUSION Some patients with hemangioma of the azygos vein arch may experience dysphagia and chest tightness caused by the tumor compressing the esophagus and trachea.Enhanced computed tomography scanning is vital for the diagnosis of azygos vein aneurysms.In addition,despite the difficulty and risk of surgery,thoracoscopic surgery for azygos vein aneurysms is completely feasible.

Unicentric Castleman's Disease with Cardiovascular Involvement

CASTLEMAN＇S disease（CD）,a rare lymphoproliferative disorder of unknown etiology, was first described in 1956 as a benign mass in the mediastinum. Although CD can present anywhere in the body, 70% of the cases are in the chest along the tracheobronchial tree or hilum of the lung in the middle mediastinum; however, they can also occur in the anterior or posterior compartments. CD is classi-fied as unicentric （UCD） or multicentric （MCD） based on the anatomical distribution, and histologically as hya-line-vascular, plasma cell, or mixed subtypes.1 Although MCD is less common than UCD, it can be rapidly pro-gressive and often fatal.

Peripheral primitive neuroectodermal tumor of the posterior mediastinum: A case report

Peripheral primitive neuroectodermal tumor(pPNET) is an extremely rare disease entity of malignant tumors belonging to the Ewing sarcoma family that usually occurs in children and adolescents. We describe a 41-year-old female who presented with right upper abdominal pain. Surgical resection and biopsy revealed small round-cell tumor. Combined with immunohistochemical analysis, pPNET was diagnosed. No evidence of recurrence was noted at 18 months postoperatively. Even thought pPNET is a highly malignant tumor, Wide tumor-free resection and multi-agent chemotherapy can also obtain good clinical outcomes.

Minimally invasive approaches for histological diagnosis of anterior mediastinal masses

Background Anterior mediastinal masses include a wide variety of diseases from benign lesions to extremely malignant tumors. Management strategies are highly diverse and depend strongly on the histological diagnosis as well as the extent of the disease. We reported a prospective study comparing the usefulness of core needle biopsy and mini-mediastinotomy under local anesthesia for histological diagnosis in anterior mediastinal masses. Methods Atotal of 40 patients with masses of unknown histology and located either at or near the anterior mediastinum received biopsy prior to treatment. The diagnostic methods were core needle biopsy in 28 patients and biopsy through mini-mediastinotomy under local anesthesia in 15 patients （including 3 patients for whom core needle biopsy failed to yield a definite diagnosis）. Results Histological diagnosis was achieved in 18 of the 28 patients receiving core needle biopsy. Of them, all 4 patients with pleural fibromas and 9 of the 12 patients （75%） with pulmonary mass were diagnosed definitively. In the remaining 12 patients with mediastinal mass, histological diagnosis was achieved in only 5 patients （41.7%）. In contrast, biopsy through a mini-mediastinotomy failed in only 3 patients. In the remaining 12 patients with huge mediastinal masses, who underwent mini-mediastinotomy, a definitive histological diagnosis was reached by pathological and/or immunohistochemical study （diagnostic yield 85.7% in 12 of 14 cases of mediastinal mass, P=0.038 vs core needle biopsy）. For the 9 patients with thymic epithelial tumors, the diagnostic yield was 40% （2 in 5 cases） for core needle biopsy and 83.3% （5 in 6 cases） for mini-mediastinotomy. There was no morbidity in patients receiving mini-mediastinotomy. In the 30 patients with biopsy-proven histological diagnosis, the results contributed to therapeutic decision making in 25 cases （83.3%）.Conclusions Core needle biopsy is effective in the diagnosis of pulmonary and pleural diseases. Yet its diagnostic yield in mediastinal mass is rather low. Superior to core needle biopsy, biopsy through a mini-mediastinotomy under local anesthesia is highly effective in the histological diagnosis of anterior mediastinal mass, and has a satisfactory diagnostic yield. The method is safe, minimally invasive, cost-effective, and useful in therapeutic decision making for anterior mediastinal masses.

Surgical management of mediastinal tumor invading the heart and large blood vessels

Background Surgical removal plays an irreplaceable important role in mediastinal tumor therapy. With advances of anesthesia, cardiopulmonary bypass and vascular surgery technology, even tumor invading the heart and great vessels can also be removed. Patients get good results after radical surgery. Methods Review The perioperative treatment was reviewed for 36 patients with complicated mediastinal tumor involving the heart and great vessels from February 1997 to March 2014. Out of them, 2 patients underwent extracorporeal circulation; one patient underwent superior vena cava and left innominate vein replacement besides the resection of mediastinal tumor; one did superior vena cava replacement, 3 patients received partial right atrial resection, 5 did superior vena cava angioplasty, 4 did innominate vein resection, 5 did innominate vein angioplasty, 10 did partial excision and repair of pericardium, 8 did pulmonary wedge resection successfully,and 2 did lobectomy. Results All 36 procedures were completed with no perioperative death. Clinical outcome was satisfactory. Conclusions Surgical management for complicated mediastinal tumor invading the heart and great vessels is difficult and risky. Therefore, comprehensive perioperative preparation and appropriate surgical procedures are indispensable for a successful surgery and desirable therapeutic effect.